Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair

Manish Mehta, Frank J. Veith, R. Clement Darling, Sean P. Roddy, Takao Ohki, Evan C. Lipsitz, Philip S K Paty, Paul B. Kreienberg, Kathleen J. Ozsvath, Benjamin B. Chang, Dhiraj M. Shah

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Purpose: Hypogastric artery interruption is sometimes required during aortoiliac aneurysm repair. We have not experienced some of the life-threatening complications of pelvic ischemia reported by others. Therefore we analyzed our experience to identify factors that help minimize pelvic ischemia with unilateral and bilateral hypogastric artery interruption. Methods: From 1995 to 2003, 48 patients with aortoiliac aneurysm required interruption of both hypogastric arteries as part of endovascular (n = 32) or open surgical (n = 16) repair. During endovascular aneurysm repair coils were placed at the origin of the hypogastric arteries, and bilateral hypogastric artery interruptions were staged at 1 to 2 weeks when possible. Open surgery necessitated oversewing or excluding the origins of the hypogastric arteries and extending the prosthetic graft to the external iliac or femoral artery. Collateral branches from the external iliac and femoral arteries were preserved, and patients received systemic heparinization (50 units/kg). Results: There was no buttock necrosis, ischemic colitis requiring colon resection, or death with the bilateral hypogastric artery interruption. Initially buttock claudication developed in 20 patients (42%), but persisted in only 7 patients (15%) at 1 year. New onset of impotence occurred in 4 of 28 patients (14%), and there were no neurologic deficits. Conclusions: Bilateral hypogastric artery interruptions can be accomplished with limited morbidity. When hypogastric artery interruption is needed during endovascular aneurysm repair, certain principles help minimize pelvic ischemia. These include hypogastric artery interruption at its origin to preserve the pelvic collateral vessels, staging bilateral hypogastric artery interruptions when possible, preserving collateral branches from the femoral and external iliac arteries, and providing adequate heparinization of the patient during these procedures.

Original languageEnglish (US)
Pages (from-to)698-702
Number of pages5
JournalJournal of Vascular Surgery
Volume40
Issue number4
DOIs
StatePublished - Oct 2004
Externally publishedYes

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Aneurysm
Arteries
Iliac Artery
Buttocks
Ischemia
Femoral Artery
Ischemic Colitis
Erectile Dysfunction
Neurologic Manifestations
Thigh
Colon
Necrosis
Morbidity
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. / Mehta, Manish; Veith, Frank J.; Darling, R. Clement; Roddy, Sean P.; Ohki, Takao; Lipsitz, Evan C.; Paty, Philip S K; Kreienberg, Paul B.; Ozsvath, Kathleen J.; Chang, Benjamin B.; Shah, Dhiraj M.

In: Journal of Vascular Surgery, Vol. 40, No. 4, 10.2004, p. 698-702.

Research output: Contribution to journalArticle

Mehta, M, Veith, FJ, Darling, RC, Roddy, SP, Ohki, T, Lipsitz, EC, Paty, PSK, Kreienberg, PB, Ozsvath, KJ, Chang, BB & Shah, DM 2004, 'Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair', Journal of Vascular Surgery, vol. 40, no. 4, pp. 698-702. https://doi.org/10.1016/j.jvs.2004.07.036
Mehta, Manish ; Veith, Frank J. ; Darling, R. Clement ; Roddy, Sean P. ; Ohki, Takao ; Lipsitz, Evan C. ; Paty, Philip S K ; Kreienberg, Paul B. ; Ozsvath, Kathleen J. ; Chang, Benjamin B. ; Shah, Dhiraj M. / Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. In: Journal of Vascular Surgery. 2004 ; Vol. 40, No. 4. pp. 698-702.
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abstract = "Purpose: Hypogastric artery interruption is sometimes required during aortoiliac aneurysm repair. We have not experienced some of the life-threatening complications of pelvic ischemia reported by others. Therefore we analyzed our experience to identify factors that help minimize pelvic ischemia with unilateral and bilateral hypogastric artery interruption. Methods: From 1995 to 2003, 48 patients with aortoiliac aneurysm required interruption of both hypogastric arteries as part of endovascular (n = 32) or open surgical (n = 16) repair. During endovascular aneurysm repair coils were placed at the origin of the hypogastric arteries, and bilateral hypogastric artery interruptions were staged at 1 to 2 weeks when possible. Open surgery necessitated oversewing or excluding the origins of the hypogastric arteries and extending the prosthetic graft to the external iliac or femoral artery. Collateral branches from the external iliac and femoral arteries were preserved, and patients received systemic heparinization (50 units/kg). Results: There was no buttock necrosis, ischemic colitis requiring colon resection, or death with the bilateral hypogastric artery interruption. Initially buttock claudication developed in 20 patients (42{\%}), but persisted in only 7 patients (15{\%}) at 1 year. New onset of impotence occurred in 4 of 28 patients (14{\%}), and there were no neurologic deficits. Conclusions: Bilateral hypogastric artery interruptions can be accomplished with limited morbidity. When hypogastric artery interruption is needed during endovascular aneurysm repair, certain principles help minimize pelvic ischemia. These include hypogastric artery interruption at its origin to preserve the pelvic collateral vessels, staging bilateral hypogastric artery interruptions when possible, preserving collateral branches from the femoral and external iliac arteries, and providing adequate heparinization of the patient during these procedures.",
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T1 - Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair

AU - Mehta, Manish

AU - Veith, Frank J.

AU - Darling, R. Clement

AU - Roddy, Sean P.

AU - Ohki, Takao

AU - Lipsitz, Evan C.

AU - Paty, Philip S K

AU - Kreienberg, Paul B.

AU - Ozsvath, Kathleen J.

AU - Chang, Benjamin B.

AU - Shah, Dhiraj M.

PY - 2004/10

Y1 - 2004/10

N2 - Purpose: Hypogastric artery interruption is sometimes required during aortoiliac aneurysm repair. We have not experienced some of the life-threatening complications of pelvic ischemia reported by others. Therefore we analyzed our experience to identify factors that help minimize pelvic ischemia with unilateral and bilateral hypogastric artery interruption. Methods: From 1995 to 2003, 48 patients with aortoiliac aneurysm required interruption of both hypogastric arteries as part of endovascular (n = 32) or open surgical (n = 16) repair. During endovascular aneurysm repair coils were placed at the origin of the hypogastric arteries, and bilateral hypogastric artery interruptions were staged at 1 to 2 weeks when possible. Open surgery necessitated oversewing or excluding the origins of the hypogastric arteries and extending the prosthetic graft to the external iliac or femoral artery. Collateral branches from the external iliac and femoral arteries were preserved, and patients received systemic heparinization (50 units/kg). Results: There was no buttock necrosis, ischemic colitis requiring colon resection, or death with the bilateral hypogastric artery interruption. Initially buttock claudication developed in 20 patients (42%), but persisted in only 7 patients (15%) at 1 year. New onset of impotence occurred in 4 of 28 patients (14%), and there were no neurologic deficits. Conclusions: Bilateral hypogastric artery interruptions can be accomplished with limited morbidity. When hypogastric artery interruption is needed during endovascular aneurysm repair, certain principles help minimize pelvic ischemia. These include hypogastric artery interruption at its origin to preserve the pelvic collateral vessels, staging bilateral hypogastric artery interruptions when possible, preserving collateral branches from the femoral and external iliac arteries, and providing adequate heparinization of the patient during these procedures.

AB - Purpose: Hypogastric artery interruption is sometimes required during aortoiliac aneurysm repair. We have not experienced some of the life-threatening complications of pelvic ischemia reported by others. Therefore we analyzed our experience to identify factors that help minimize pelvic ischemia with unilateral and bilateral hypogastric artery interruption. Methods: From 1995 to 2003, 48 patients with aortoiliac aneurysm required interruption of both hypogastric arteries as part of endovascular (n = 32) or open surgical (n = 16) repair. During endovascular aneurysm repair coils were placed at the origin of the hypogastric arteries, and bilateral hypogastric artery interruptions were staged at 1 to 2 weeks when possible. Open surgery necessitated oversewing or excluding the origins of the hypogastric arteries and extending the prosthetic graft to the external iliac or femoral artery. Collateral branches from the external iliac and femoral arteries were preserved, and patients received systemic heparinization (50 units/kg). Results: There was no buttock necrosis, ischemic colitis requiring colon resection, or death with the bilateral hypogastric artery interruption. Initially buttock claudication developed in 20 patients (42%), but persisted in only 7 patients (15%) at 1 year. New onset of impotence occurred in 4 of 28 patients (14%), and there were no neurologic deficits. Conclusions: Bilateral hypogastric artery interruptions can be accomplished with limited morbidity. When hypogastric artery interruption is needed during endovascular aneurysm repair, certain principles help minimize pelvic ischemia. These include hypogastric artery interruption at its origin to preserve the pelvic collateral vessels, staging bilateral hypogastric artery interruptions when possible, preserving collateral branches from the femoral and external iliac arteries, and providing adequate heparinization of the patient during these procedures.

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